Provider Demographics
NPI:1487818977
Name:LANNUTTI, ELEANOR DELANEY (DO)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:DELANEY
Last Name:LANNUTTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:ANNE
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 W 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4506
Mailing Address - Country:US
Mailing Address - Phone:240-566-3300
Mailing Address - Fax:
Practice Address - Street 1:9507 HOSPITAL AVE.
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-414-8000
Practice Address - Fax:757-414-8618
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202825208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487818977Medicaid
VAP00969584Medicare PIN
VA1487818977Medicaid